Simple schizophrenia - when the name is deceiving

The question of the boundaries of schizophrenia as an independent mental disorder or a separate nosological unit is one of the key ones in medicine.

Despite the almost century-long history of the existence of the concept of “schizophrenia,” there is still no consensus on the clinical criteria for defining this disease. Perhaps here lies the reason for the fruitless search for the etiology and pathogenesis of schizophrenia and, in part, for the modest results of its treatment.

The constantly expanding range of instrumental methods for studying schizophrenia and the increasing accuracy of research results come into real conflict with the vagueness of its clinical boundaries and insufficient differentiation of clinical material as an object of study.

The diversity of clinical manifestations of schizophrenia, the wide variety of variants of its course, as well as outcomes, blur its clinical boundaries.

What does a diagnosis of schizophrenia mean? Does it indicate any changes in brain structures or dysfunction of the central nervous system, does it imply a response to a certain method of therapy or the likely course and outcome of the disease?

The criteria for the diagnosis of schizophrenia were often determined by the theoretical views of psychiatrists of the time in which they worked and the country in which they lived.

Throughout the twentieth century, the boundaries of schizophrenia either expanded or narrowed, to the point of its denial as an independent nosological form.

Traditionally, when diagnosing schizophrenia, psychiatrists paid attention to the clinical manifestations of its onset, the characteristics of its course, and most importantly, the outcome.

There was an opinion that it was impossible to diagnose schizophrenia on the basis of the patient’s current mental status; it was necessary to assess the history of his life and illness in the past, and most importantly, to observe the dynamics of the course of the disease in the future, and for a sufficiently long time to confirm the diagnosis.

The diagnosis of schizophrenia in some cases was made hastily, based on the relative specificity of productive symptoms, for example, the presence of pseudohallucinations or paranoid syndrome. At one time, this approach was quite typical for many American psychiatrists and was reflected in the DSM-1V.

In the domestic literature of the 50s of the twentieth century, the dominant point of view was that schizophrenia was considered a single group of related diseases (Banshchikov V.M., 1958).

Many doctors, faced with the varied clinical picture of the disease, assured that schizophrenia is characterized by polymorphism and variability of symptoms as the disease progresses.

According to M. Bleuler, three main diagnostic criteria for schizophrenia can be distinguished: the presence of manifest manifestations; fragmentation of thinking, emotional, motor, splitting; depersonalization, mental automatisms, catatonia, delusions, hallucinations; absence of syndromes of exogenous type reactions.

W. Mayer-Gross (1930) for the diagnosis of schizophrenia proposed to identify such primary symptoms as: thinking disorders, passivity with a feeling of influence; primary delusions with ideas of relation; emotional flatness; catatonic behavior; the sound of your own thoughts.

Some psychiatrists believed that there were no clinical syndromes specific to schizophrenia, and that every symptom found in this disease could be found in other mental disorders.

This point of view was contrary to the generally accepted view that there are symptoms specific to schizophrenia, and these are the basis for making a diagnosis of the disease.

Many clinicians note that when talking with a patient who is suspected of schizophrenia, in order to eliminate prejudice, only lastly should one pay attention to the family history and then analyze in detail cases of mental disorder in the patient’s relatives.

Currently, many psychiatrists are increasingly calling for the need to objectify the clinical diagnosis of schizophrenia based on a wide range of biological markers of this mental disorder (Helmchen H., 1988).

The primary diagnosis of schizophrenia requires a medical history and a complete somato-neurological examination of the patient. Neurophysiological (EEG, CT, MRI, etc.) and cardiac examination, analysis of laboratory data, including tests for the presence of drugs, are required.

In case of obvious neurological disease of the brain, infectious or intoxication damage, it is not recommended to make a diagnosis of schizophrenia.

Examination of patients in a state of acute psychosis or its continuous but prolonged course is difficult to implement in practice.

A patient with schizophrenia is convinced of the reality of his experiences, believes only himself, is often wary and suspicious, tense, afraid. He often denies the presence of a mental disorder. Due to the above, assessment of the nonverbal behavior of patients is of particular importance for diagnosing schizophrenia. According to V.P. Samokhvalova et al. (1985, 1989), of the total number of diagnostically significant features of non-verbal behavior for schizophrenia, 44.2% of the signs are deficit symptoms, 29.5% are catatonic, 21.3% are depressive and only 5% are paranoid schizophrenia syndrome .

Medical personnel faced with the onset of schizophrenia usually do not have enough time to form a trusting relationship with the patient. Attempts to penetrate into the mental world of the patient often meet with pronounced resistance.

The situation can be complicated by relatives who underestimate or, on the contrary, overdramatize what is happening.

Timely diagnosis of schizophrenia is complicated by the fact that its debut often occurs in adolescence (Tatarenko N.P., 1962) - a period where it is difficult to differentiate the initial symptoms of the disease and premorbid personality characteristics. Even normally, adolescents may experience manifestations of mental activity that outwardly resemble symptoms of schizophrenia, such as stereotypical behavior, grimaces, foolishness, or neologisms. Some syndromes of the disease (hypochondriacal, dysmorphophobic, depressive) can occur monosyndromously. In these cases, personality changes characteristic of schizophrenia are not detected for a long time.

According to G.E. Sukhareva (1974), in the process of diagnosing schizophrenia, one cannot use the summary concept of “schizophrenia”. It is necessary to determine the clinical form, stage of the disease, and the degree of its progression.

The vagueness of the clinical boundaries of schizophrenia over a long period of time has made it difficult to classify this disease and has been the source of discrepancies in epidemiological studies of schizophrenia in different countries.

In 1972, the Diagnostic Project (USA/UK) showed that the diagnosis of schizophrenia was much more common in the US than in the UK. In a series of 250 cases in New York, 62% of patients were diagnosed in hospital with schizophrenia, while in London the figure was 34%.

Many psychiatrists believe that a diagnosis of schizophrenia cannot be made based solely on the presence of individual symptoms, such as hallucinations or delusions.

To diagnose schizophrenia, it is important to remember that an experienced psychiatrist can identify the signs of this mental disorder from the patient’s childhood; we are primarily talking about peculiar negative symptoms and manifestations of neurocognitive deficit.

For modern diagnosis of schizophrenia, the general principles of clinical diagnosis, formulated in particular by the classics of Russian medicine, are still relevant. So, according to V.Kh. Vasilenko, diagnosis is not just a brief medical opinion about the essence of the disease and the patient’s condition, expressed in medical terms. Diagnostics involves the entire process of studying the patient: observation, identification of symptoms, and their assessment from the point of view of correlating the anatomical and physiological characteristics of a person with the environment, and assessment of their connection with each other (syndromatics), and assessment of the variability of the syndrome (course), and diagnostic the meaning of the symptom and syndrome (semiology), and the peculiarities of thinking in recognizing the disease (diagnosis method).

Schizophrenia: types of disease course

This disease does not always manifest itself in the same way in everyone - it comes in different types and can have different types of course.

There are three main types of schizophrenia: continuous-progressive, paroxysmal-progressive and paroxysmal. The continuously progressive type also includes two subtypes: sluggish and moderately progressive. Let's take a closer look:

Continuous-progressive type of course: painful symptoms increase continuously, without remission, until a so-called schizophrenic defect is formed (this takes an average of 5 years);

• sluggish subtype: the formation of an apathetic-dissociative defect (schizophrenic dementia) takes 15-20 years,
• medium progradient subtype: schizophrenic defect is formed in approximately 10 years,
• malignant: a schizophrenic defect is formed within 2-4 weeks.

Paroxysmal-progressive type of course (fur-like): the symptoms of the disease increase, then their development stops (remission occurs), and after some time the next attack occurs.

Paroxysmal (circular, recurrent, periodic) type of course: symptoms of schizophrenia appear, then after the exacerbation is completed and remission occurs, and so on until the next attack.

A characteristic feature is that the closer the type of schizophrenia is to paroxysmal, the more emotional disorders (depression, mania, etc.) are in the clinical picture.

Difficulties in diagnosis

It is not always possible to easily diagnose this disease , since its initial symptoms are very similar to the behavioral changes characteristic of adolescence.

The transitional age is one of the most important and difficult for a person, since the child is looking for his place in the world, although he often lacks the knowledge to fully understand and understand what is happening around him.

Also, hormonal changes in the body affect the child’s behavior, and he cannot always control his emotions and correctly express his own thoughts. Because of these characteristics, many adults do not always react to the behavior of a teenager, associating it with hormones in the body, considering his actions normal.

But it is very important to diagnose the disorder as quickly as possible, since schizophrenia in the early stages is more treatable . Many psychiatrists, when diagnosing the early stage, describe such symptoms.

Previously kind, well-mannered, purposeful children become aggressive and their attitude towards relatives and close people changes for the worse. For no particular reason, rudeness, anger, or unexpected coldness may appear in their behavior. Sometimes the child moves away from the people around him, becomes cold and spends more and more time alone.

How is psychosis different from schizophrenia?

This is very noticeable, especially if before this the patient was positive, kind and had warm relationships with others. There may also be a decrease in school performance and shirking from household duties, apathy towards any mental or physical activity.

Sometimes children even neglect their own hygiene.

The adults around the child need to be very attentive in order to be able to distinguish the fine line between a child who has changed his behavior due to adolescence and a child with schizophrenia. Otherwise, the development of schizophrenia can lead to personality disintegration.

At the second stage, you can observe signs that clearly indicate the presence of mental disorders.

In this case you will see:

• reduced social activity and apathy;
• reduction of facial diversity;
• thinking disorders;
• decrease in vocabulary.

The patient’s speech becomes poorer, emotional intensity is reduced, a tendency to vagrancy and a break in social ties may appear due to social maladjustment. Very often, patients can experience eating disorders, which can be expressed, for example, by gluttony or anorexia nervosa.

All people with schizophrenia are alike. They lack initiative and are also unemotional. All actions of patients are repeated monotonously day after day, the person performs them automatically. Over time, the patient loses the ability to learn and absorb new material.

Also, a sign characteristic of the second stage of the disease is unfinished sentences. The patient does not bring his phrases to their logical conclusion. A quick transition in conversation from one topic to another, not related to the original one, is another characteristic feature of this stage.

Sometimes, in advanced cases, a person’s speech can be composed only of unrelated fragments of phrases that cannot be logically connected to each other. Some words lose their familiar sound or are replaced by new words.

Although this disease is not characterized by persistent delusions and the occurrence of visual or auditory hallucinations, sometimes you can observe how the patient seems to be listening carefully to something.

When diagnosing, psychiatrists do not rely on individual symptoms, but on all clinical signs in total. This includes information about cases of illness in the family and the development of a person throughout his life.

Schizophrenia megalomania

Schizophrenia: types

The disease in question tends to take on various forms. Often, depending on the clinical manifestations of symptoms and based on the International Classification of Diseases, 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-4), the authors identify the following clinical forms of schizophrenia:

• simple – there are no delusions and hallucinations;
• paranoid – hallucinatory-paranoid symptoms are observed;
• hebephrenic (ICD) – the presence of peculiar catatonic symptoms reminiscent of childhood pampering and foolishness;
• catatonic, which is accompanied by catatonic symptoms;
• undifferentiated schizophrenia – when the diagnostic criteria for schizophrenia are not specific to any one type;
• residual (residual) - synonym - incomplete remission, when negative and positive symptoms remain in the form of residual symptoms;
• post-schizophrenic depression syndrome, which is characterized by the presence of depressive symptoms and occurs after an exacerbation of schizophrenia.

All these forms contain obligate symptoms - apathy, dissociation, autism. They differ in additional (non-obligate symptoms) - delusions, hallucinations.

Reasons for development

Until now, the scientific community cannot reach full agreement in this discussion. For example, researchers such as Jaspers and Leonhard doubt that simple form can be considered as a separate phenomenon.

Spring exacerbation of schizophrenia

They tend to consider it a special case of paranoid schizophrenia, or a clinical variant of disorganized schizophrenia, which also begins in adolescence and has similar symptoms.

Also, scientists who study this problem do not have a consensus on the reasons leading to the emergence of a simple form of schizophrenia.

There are several theories:

1. Hereditary predisposition . According to this theory, those at risk are people whose close relatives suffered from the same disorder. Predisposition to the disease is transmitted genetically.
2. Biochemical factors and lack of certain elements that are necessary for the normal functioning of the body.
3. Mental instability . Thus, the negative impact of the environment on the human psyche, under conditions of great pressure, can break a person, which will be the cause of the disease. Large amounts of stress can have a detrimental effect on a person's mental health.
4. Somatic diseases , as well as brain lesions.
5. Character traits . People who are very introverted and extremely timid may also be at risk.

Paranoid schizophrenia

This type of schizophrenia is one of the most common and is diagnosed in more than 60% of cases. A characteristic feature of this type of schizophrenia is thought disorders in form, which reflects the “experience” of the disease, as well as in content in the form of delusional ideas (delusions are false conclusions that cannot be dissuaded and with a complete lack of criticism on the part of the patient). Also, this clinical form of the disease is characterized by perception disorders in the form of hallucinatory symptoms (usually verbal auditory hallucinations - commentary and imperative). In the paranoid form of schizophrenia, motor (catatonic) symptoms often occur (catatonic agitation, catatonic stupor, negativism, automatic obedience, ambivalence, ambitendence). Over time, a schizophrenic defect is formed, which is manifested by disorders of the emotional and volitional sphere.

general information

Schizophrenia is a serious mental disorder (psychosis), with a disease duration of six months or more. The diseases accompany significant disturbances in the social, work and personal spheres of the patient’s life. The disease has a progressive course (with an increase in personality defect). The disease is described in the International Classification of Diseases, 10th revision (ICD-10) under heading F20.

The disease in men and women can have four course options :

• gradual progressive continuous;
• rapid continuous;
• paroxysmal;
• paroxysmal-progressive (progression of symptoms during and after the next attack).

The disease in women and men is generally characterized by:

• the fundamental disintegration of the sphere of thinking and perception (alogy);
• distancing (withdrawal) from the external environment with introversion (immersion in one’s inner world, the so-called symptom of autism);
• the existence of diverse affects in the psyche (ambivalence);
• inadequacy of emotional reactions;
• illogical behavior;
• decreased energy potential and apathy.

The most common manifestations of schizophrenia are productive (positive) symptoms: verbal pseudohallucinations, paranoid or fantastic delusions and (or) deficit (negative) symptoms: disorganization of speech, fragmented and illogical thinking, significant social dysfunction, loss of ability to work. The diversity and variable combination of clinical symptoms in children and adults confirms the hypothesis that schizophrenia is not a single mental illness, but represents a number of separate schizophrenic disorders.

Hebephrenic schizophrenia

This type of schizophrenia has a rather negative “reputation” and an extremely unfavorable prognosis. Symptoms increase extremely rapidly, progress quickly, and the course is continuous. It predominantly develops during puberty, for which it is also nicknamed “teenage” schizophrenia. The name “hebephrenic” is also associated with youth, in honor of the ancient Greek goddess of youth Hebe. Emotional and thinking disorders are expressed, sometimes they are occasionally supplemented by hallucinations and delusions. The onset of the disease in this type is acute. Hebephrenic schizophrenia often manifests itself with increased activity, foolishness and causeless laughter, short temper, grimacing, increased appetite and sexual activity, perversity, mannerisms, and unnatural behavior. Such patients are more like theater actors playing the role of a small child.

Classification

The disease can occur as follows:

1. Continuously progressive form with rapid or gradual development of manifestations of the disorder.
2. Paroxysmal

• paroxysmal-progressive (fur-like);
• periodic (recurrent).

Based on the rate of formation of the clinical picture, the following forms are distinguished:

• Rapidly progressive (malignant);
• Moderately progressive (paranoid);
• Low-progressive (sluggish).

In its development, schizophrenia goes through several stages (stages), with the exception of the recurrent form:

• The initial stage is the period from the appearance of the first prodromal symptoms (asthenic status to manifest signs of psychosis (pseudo-hallucinations or hallucinations, delusions).
• The manifest (initial) stage is the period during which the patient develops both productive and deficient symptoms.
• The final (final) stage is the stage at which negative symptoms prevail over positive ones, and a “freezing” of the patient’s mental state is recorded.

Schizophrenic disorders are represented by separate forms of the disease, which are characterized by distinctive signs and features:

• paranoid;
• hebephrenic;
• catatonic;
• residual;
• simple.

Catatonic schizophrenia

This type is characterized by movement disorders. This is usually either inhibition or excitation. When braking (stupor), a person takes a variety of unnatural positions and can hold them for quite a long time without any inconvenience. When catatonic stupor occurs, speech and facial expressions slow down or are absent in patients. The clinical picture with catatonic excitement is radically different: a person’s speech and facial expressions accelerate, he can smash and destroy everything, but his actions are not aimed at harming the people around him. There may also be catatonic symptoms such as negativism (active - when asked, patients do the opposite, passive negativism, when they do not fulfill requests and demands), automatic submission, manifestations of duality - the simultaneous coexistence of opposing desires (ambivalence) and actions (ambitendency).

Precursors and clinical symptoms

Recent extensive research has shown that the onset of schizophrenia may be preceded by the appearance of nonspecific prodromal symptoms. Moreover, the onset of the prodrome occurs over a rather distant period - more than 30 months before the appearance of obvious clinical symptoms of the disease. Prodromal symptoms are:

• conscious voluntary social isolation, isolation, separation from society;
• excessive irritability in the absence of compelling strong incentives;
• feeling of hostility towards others;
• painfully low, gloomy mood;
• emotional coldness;
• decreased or lost ability to experience pleasure;
• lack of attempts to achieve benefits and benefits;
• lack of motivation to activity.

More than 40% of patients have traits of a schizoid personality type before the development of clinical symptoms of schizophrenia.

Undifferentiated schizophrenia

If a person exhibits signs of a psychotic disorder that meet the general diagnostic criteria for schizophrenia, but do not absolutely coincide with any of the above types, we can talk about making a diagnosis of “undifferentiated schizophrenia.” Often this diagnosis only indicates the doctor’s inability to observe the patient’s behavior over a sufficiently long period of time. At the same time, this does not indicate the controversial nature of the diagnosis - symptoms characteristic of a schizophrenic disorder exist, but determining the form of schizophrenia is not possible.

Positive and negative symptoms

Schizophrenia occurs in certain stages: its manifestations naturally change during the course of the disease. Like any other psychosis, schizophrenic disorder is represented by two groups of symptoms :

• positive (productive);
• negative (deficient).

Productive symptoms are a kind of additional components that indicate excessive mental activity. Positive symptoms are some new mental phenomenon, some newly formed function that was absent before the illness, some “mental reflection without a real object. Productive symptoms include: delirium,

• frequent and prolonged hallucinations (pseudohallucinations), accompanied by conversations with an imaginary interlocutor;
• psychomotor agitation;
• obsessions;
• disorganization syndrome (chaotic speech, fragmented thinking, inconsistent behavior).

Deficit symptoms imply a “loss” of previously existing characteristics from the spectrum of a person’s mental activity. Negative symptoms are an irreversible loss of existing mental functions. Deficient symptoms are represented by the following signs:

• reduction in energy potential;
• indifference, indifference, detachment from everything that happens;
• disorders of thinking, perception, attention;
• paucity of speech activity;
• inability to experience pleasure;
• deterioration of the emotional response and decrease in the brightness of experiences;
• loss of motivation and desire;
• lack of volitional motivation for activity;
• catatonic stupor (silence, freezing in one position).

Postschizophrenic depression

This condition can occur following an attack of schizophrenia, or after it. Sometimes, with post-schizophrenic depression, residual signs of psychosis, “negative” and “positive” symptoms, are observed, but they no longer have a dominant role in the clinical picture and their severity is no longer intense. It is a kind of marker of complete remission. These patients have an increased risk of suicide.

Despite the great variety and variety of manifestations of such a disease as schizophrenia, almost all of them can and, most importantly, must be fought! Life can yet become fulfilling again!

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The most effective treatments

The drugs used in treatment are antipsychotics , antidepressants , psychostimulants and other medications that normalize metabolism and brain activity. The use of traditional antipsychotics is undesirable , as this can only aggravate negative symptoms.

Treatment of a simple type most often does not require hospitalization and occurs on an outpatient basis, but if the patient is hungry, has thoughts of suicide, or shows strong aggression towards others, then hospitalization is necessary. This is necessary so that the patient does not harm himself or the people around him.

It is important for the patient to take the medications prescribed to him on time, and also to be constantly under the supervision of a doctor, regularly visiting him to adjust the dosage and list of medications. It is advisable for the patient to adhere to proper nutrition so that his body receives all the necessary microelements.

Treatment should consist not only of medication, but also psychotherapy, which involves psychotherapy for the patient and his family. Such sessions are aimed primarily at rehabilitating the patient for life in society.

Only comprehensive treatment will help to get good results and speed up recovery. But patients do not always believe that they need medical care and deviate from interacting with a doctor.

Even despite remission, the patient will still need maintenance therapy, as well as a course of adaptation to society. Of course, cases of complete recovery from schizophrenia have occurred very rarely, but high-quality and timely treatment will help reduce the rate of progression of the disease, reduce the manifestation of symptoms, and also speed up the onset of remission.

The development of modern medicine allows a patient with schizophrenia to live normally to one degree or another. Since this form mainly affects adolescents, it is very important to predict the disease as early as possible in order to save the child from irreversible consequences.

Recurrent type ↑

According to descriptions of this type, it affects predominantly middle-aged women (20-40 years old). The pathology is characterized by the occurrence of vivid and severe mental episodes, after which a long-term remission occurs. Obligate symptoms progress slowly, and personality changes begin to be observed only after a series of mental episodes. When remission occurs after the first or second episode, the patient seems absolutely healthy, no noticeable changes are observed. Psychoses can have three development options:

• Oneiric catatonia, this condition manifests itself either in a stupor. The patient may remain in an uncomfortable and unnatural position for a long time; this condition is often accompanied by mutism, that is, complete silence. In this case, not only the body takes an uncomfortable position, but also the facial expressions are absent, it becomes like a mask. Catatonia can also manifest itself as a state of excitement, stereotypical actions and impulsive aggression appear. The patient can break and destroy everything in his path;
• A depressive-paranoid state manifests itself in depression with fears and anxiety. Delusions of staging and condemnation, as well as verbal illusions, arise. During remission, ability to work remains, although slightly reduced. Remission is accompanied by a feeling of anxiety with a somewhat pessimistic background;
• bipolar schizophrenia in this case, the course of the disease is characterized by sudden changes in mood and emotional background. Frequent cases of suicide occur precisely with this form of development of a mental episode. Often there is an alternation of manic and depressive states. In this condition, the patient experiences speech disturbances, abruptness and incompleteness of thought, absent-mindedness and poor sleep.

An important role in the depth of recovery and aggravation of the situation in the course of schizophrenia depends on the prescribed therapy. Both drug treatment and psychotherapy with patients and their relatives are important. For each individual case, a different set of drugs is prescribed, depending on which clinical manifestations dominate. Antipsychotic drugs are always the basis of treatment, and depending on the symptoms, they are supplemented with antidepressants, nootropics, vitamins, psychotropic substances, etc.

The fur-like course of schizophrenia is more common than the continuous and recurrent type; according to various authors, it is diagnosed in 54-72% of cases. The most favorable course is observed with the recurrent type, followed by the paroxysmal-progressive type. The continuous type, especially if the disease developed at a young age, has the most negative prognosis; increasing manifestations during a mental episode lead to a persistent personality defect.

Author: Folded Julia

Description

Patients are characterized by premorbid personality traits such as shyness, timidity, fearfulness, infantilism[4], as well as pronounced schizoid traits - from excessive sensitivity and vulnerability to apathy, coldness and “affective dullness”[5].

At the beginning of the course of the disease, mental disorder is expressed in an intensification of features reminiscent of character accentuation, and then a distortion of the features occurs [5]. The personality of diligent, obedient, polite teenagers suddenly changes: they become rude in communication, lose feelings for close relatives or even begin to show hatred and unreasonable cruelty towards them, stop attending classes, lie aimlessly on the bed and feel indifference to useful activities, sleep for a long time or wander, neglect the rules of hygiene and do not take care of their clothing[4]. The voice becomes monotonous, and facial expressions and motor skills are inexpressive.

Instead of productive activities, many patients begin to think about abstract topics, for example, about the problems of the universe, the meaning of life and death, and immerse themselves in the study of philosophy, linguistics and other theoretical sciences, for which they usually have no preparation, which can be considered as a symptom of metaphysical intoxication [4 ]. The patient may be engaged in constructing theories of philosophy divorced from reality, solving intricate mathematical problems, aimless invention, collecting unnecessary things, etc. [5].

Persistent hallucinations and delusions are usually absent in the simple form of schizophrenia, but such symptoms may appear over time. Catatonic or affective disorders appear less frequently[6]. Productive psychotic symptoms are also possible at the beginning of the disease, at its debut: unstable delusional ideas of persecution, relationship and special meaning may be observed [7], but after a short time it is reduced. Some researchers claim that delusions and hallucinations do not occur at all[3], only rudimentary hallucinatory disorders (“hailing”) and episodic delusional alertness may appear[4]. Adynamic depression is often observed [ source not specified 579 days

], senestopathy and dysmorphophobia[5].

Neurocognitive deficits in simple schizophrenia include memory impairment, absent-mindedness, difficulty planning activities, and poor judgment[5].

Thinking disorders may be present (“formal thinking disorders” [8], “disorders of the associative process” [9], “disorders of the thinking process” [10]). This manifests itself in impoverished speech, interruptions in the associative process (the so-called “sperrungs”), and unintentional slippage from the topic. There may be a feeling of openness of thoughts (when other people allegedly can see or hear the thoughts of patients), delay, disappearance, influx or insubordination of thoughts [3]. Stereotypes may also appear: swaying, gestures, coughing, which some researchers refer to as erased catatonic symptoms[11]. Vague hypochondriacal complaints may be present[3].

The initial period of the disease is characterized by a predominance of psychopathic-like (36.8%), neurosis-like (29%) and apatho-abulic (34.2%) symptoms [12][5]. Subsequently, there is an increase in apato-abulic syndrome and a decrease in energy potential, an increase in the phenomena of mental automatism, and the formation of a mental defect [6] [3].

Close relatives of the patient may not notice the manifestations of the disease and consider them to be a bad character or laziness[13]:18.